Clinical pharmacists’ interventions, resistance, and training needs in ICUs: a FASTHUG-MAIDENS cross-sectional study

Abstract

Introduction

To standardize and optimize daily patient assessment, many intensive care unit (ICU) clinical pharmacists worldwide have adopted FASTHUG-MAIDENS, a comprehensive mnemonic that guides systematic evaluation of essential care domains, including Feeding, Analgesia, Sedation, Thromboprophylaxis, Hyper/hypoactive delirium, Ulcer prophylaxis, Glucose control, Medication reconciliation, Antibiotics, Indications for medications, Drug dosing, Electrolytes, No drug interactions/allergies, and Stop dates. However, despite its recognized value, pharmacists may still encounter interprofessional resistance and face training gaps that hinder optimal patient care.

Aim

The objective of this study was to evaluate the key areas of ICU clinical pharmacist interventions, identify interprofessional resistance, and explore training needs within the context of the FASTHUG-MAIDENS checklist.

Methods

A cross-sectional survey was conducted in December 2024 using a self-administered online questionnaire distributed to ICU clinical pharmacists across Egypt. Descriptive statistics and Kendall’s tau-b correlation test were used to analyze the data, with a p-value < 0.05 considered significant.

Results

Of the 121 ICU clinical pharmacists surveyed, most were female (76%), under 35 years of age, and working in public hospitals, with nearly two-thirds having less than five years of experience. Across all 14 mnemonic components, interprofessional resistance was most frequently encountered in sedation, antimicrobial therapy, medication indication, and stop-date domains. The highest reported training needs were in feeding, sedation, and delirium management. A significant positive correlation was observed between perceived training needs and the frequency of encountering resistance (r = 0.655, p < 0.001).

Conclusion

Targeted education, particularly in sedation, delirium management, and nutrition, combined with strategies to address interprofessional barriers is essential to maximize pharmacists’ impact on patient care.